What is Medicare/Medicaid?
Medicare is a federal health insurance program supported through premiums and payroll taxes.
Part A is Hospital Insurance. It is available at age 65 to anyone who is eligible to collect Social Security or Railroad Retirement. It is also available to people who have been on Social Security disability for more than 24 consecutive months and those who are on dialysis. Part A helps cover hospitals, nursing homes, home health care, and hospice care.
Part A is Hospital Insurance. It is available at age 65 to anyone who is eligible to collect Social Security or Railroad Retirement. It is also available to people who have been on Social Security disability for more than 24 consecutive months and those who are on dialysis. Part A helps cover hospitals, nursing homes, home health care, and hospice care.
Part B is Medical Insurance. It is available the same as Part A. Premiums for Part B are deducted from Social Security and Railroad Retirement benefits. Medical Insurance helps to pay for physicians, durable medical equipment, outpatient services, and home health care.
Part C is the Medicare Advantage Program. Under this program private insurance companies have contracted with Medicare to provide both Part A and Part B coverage under a single plan. They may add additional coverage for services not covered by Part A and Part B. If you are under a Medicare Advantage plan you need to use the card provided by the insurance company, since that company is providing your Medicare coverage. If you use your Medicare card when you have a Medicare Advantage plan, it will delay payment to your medical providers. With some Medicare Advantage plans you must use in-network providers or you may incur financial penalties.
Part D is Medicare’s plan for Prescription Coverage. Some Medicare Advantage Plans include Part D. Otherwise, you will need to choose a participating insurance company for Part D benefits.
Medicare’s website, www.medicare.gov, contains more detailed information on each of these plans. They also have tools to help you locate insurance providers and to compare their plans.
Medicaid is a combined federal and state program which provides health coverage for people who meet strict income and asset guidelines.
In Pennsylvania the Medicaid program is called Medical Assistance, and it is abbreviated as MA. Medicaid covers costs of hospitals, nursing homes, physicians, equipment, home health and, in some cases, medications. In Pennsylvania the Department of Public Welfare (DPW) handles the Medicaid program. Their website is www.dpw.state.pa.us.
If you are not in a nursing home and are eligible for Medicaid for more than a month, you will be directed to select one of the contracted companies that provide Health Maintenance Organization (HMO) coverage for the program.
If you have both Medicare and Medicaid, you will be directed to choose one of the DPW contracted companies for a Medicare Advantage program.
If you are in a nursing home, Medicaid supplements your monthly income to pay for your care. With the high cost of nursing homes, presently averaging over $7,500 each month, (many local facilities average $8-9,000 per month) most people needing long-term care will eventually utilize Medicaid, even if they are not eligible when they enter the nursing home. There are a number of rules about what can and what cannot be done with your assets for up to five years prior to entering a nursing home. The attorneys at Keystone Elder Law understand these rules and can help you get the benefits you legally deserve, without requiring your spouse to move from your home or depriving your children of an inheritance.
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REGISTER HERE for LONG-TERM CARE PLANNINGPower of Attorney
A Power of Attorney can be used to give another person the right to sell a car, home, or other property in the place of the maker of the Power of Attorney. A Power of Attorney might be used to allow another person to sign a contract for the maker of the Power of Attorney (the person who makes a power of attorney is called the “principal”). It can be used to give another person the authority to make health care decisions, do financial transactions, or sign legal documents that the principal cannot do for one reason or another. With few exceptions, Powers of Attorney can give others the right to do any legal acts that the makers of the Powers of Attorney could do them themselves. A General Power of Attorney gives the “power of attorney Agent” or simply “Agent” (the legal name of the person who is authorized to act for the principal) very broad powers to do almost every legal act that the principal can do. When Elder Law Attorneys draft general Powers of Attorney, they still list the types of things the Agent can do but these powers are very broad. People often do general Powers of Attorney to plan ahead for the day when they may not be able to take care of things themselves. By doing the General Power of Attorney, they designate someone who can do these things for them.
Normal Powers of Attorney terminate if and when the principal becomes incompetent. Yet many people do Powers of Attorney for the sole purpose of designating someone else to act for them if they cannot act for themselves. It is precisely when persons can no longer do for themselves that a Power of Attorney is most valuable. To remedy this inconsistency, the law created a Durable Power of Attorney that remains effective even if a person becomes incompetent. The only thing that distinguishes a Durable Power of Attorney from a regular Power of Attorney is special wording that states that the power survives the principal’s incapacity. Even a Durable Power of Attorney, however, may be terminated under certain circumstances if court proceedings are filed. Most Powers of Attorney done today are durable.
Yes. At the time the Power of Attorney is signed, the principal must be capable of understanding the document. Although a Power of Attorney is still valid if and when a person becomes incompetent, the principal must understand what he or she is signing at the moment of execution. That means a person can be suffering from dementia or Alzheimer’s Disease or be otherwise incompetent sometimes but as long as they have a lucid moment and are competent at the moment they sign the Power of Attorney, it is valid even if they do not remember signing it at a later date. At the time it is signed, the principal must know what the Power of Attorney does, whom they are giving the Power of Attorney to, and what property may be affected by the Power of Attorney.
Any competent person eighteen years of age and older can serve as an agent. Certain financial institutions can also serve. There is no course of education that agent must complete or any test that Agent must pass. Because a Power of Attorney is such a potentially powerful document, agents should be chosen for reliability and trustworthiness. In the wrong hands, a Power of Attorney can be a license to steal. It can be a big responsibility to serve as an agent.
For Medicaid
Medicare is health insurance and covers medical services such as physician appointments, therapy, blood tests, x rays, medical procedures and hospitalization. Medicare will sometime pay for rehabilitation in a long-term care facility for a period of 20 to 100 days, but not longer. In long-term care, Medicaid covers the cost of ongoing support services for daily functioning, such as room and board in a nursing home.
Medicaid is a federal program that is overseen by the Center for Medicare and Medicaid Services (CMS). In Pennsylvania, Medicaid is called Medical Assistance and is administered by the Department of Human Services (DHS).
In Pennsylvania, Medicaid funds are not available to pay for assisted living or personal care.
For Medicaid to pay for care in a nursing home, an individual recipient must be determined to need a nursing home level of care by a physician and the local Office of Aging. An individual whose income is not greater than three times the poverty level may keep up to $8,000 of total resources, but may otherwise keep only $2,400. The cash value of life insurance counts as a resource, but one car and a residential home does not count as a resource.
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Keystone Elder Law
At Keystone Elder Law, we believe that the physical, social, legal, and financial considerations of our clients all intertwine. We utilize an interdisciplinary approach to evaluate each area, which allows for the creation of a plan that addresses the concerns of the individual as a whole as well as the family. To this end, our model of practice includes a Care Coordinator (usually a nurse or social worker), whose expertise complements our team of attorneys.
When the road of life is smooth, decisions about legal and financial matters are easy to push aside for “a rainy day.” Planning ahead, however, will allow for more options as you view the map of where you’ve been and where you want to go. Don’t let a crisis limit your choices or derail your plans.
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